Wherein a surgeon tells some stories, shares some thoughts, and occasionally shoots off his mouth. Like a surgeon.

Friday, August 10, 2007

Pile O' Problems

Many years ago, a friend of mine told a story that, at the time, I thought was hilarious. He'd been hospitalized -- I forget why -- and his roommate was a fellow young man who'd undergone surgery for a pilonidal cyst. The operation had involved the placing of wires, which had been tied down over buttons (the technique -- not always involving buttons and wires -- is called "marsupialization," although I didn't know it at the time.) One evening the man felt a pop and pain. He called the nurse who, after having a look, placed an urgent call for the man's surgeon. On arrival, the doctor (resident? the man's actual surgeon?) felt it necessary rapidly to dig in to retrieve the wire, and did so with a clamp, without any attempt at anesthesia. My friend was horrified by the screams of his roommate, and began yelling at the doctor and nurse to do something. "Knock him out, knock him out," he demanded. (In telling the story, he described his own drugged state, painting a bizarre picture of confusion, paranoia, and semi-stupor. And I'd be pretty sure prodigious profanity of Shakespearean quality was involved.) Seeing no attempt on anyone's part to reduce the pain of his neighbor, he finally starting throwing things at the man's head, trying in his own way to knock him out. First some books, then the phone, and finally an IV bottle. (I must interject that my friend happened to be one of the funniest people on Earth, and could have elicited helpless laughter in the reading of a water-meter. Plus, this being a long time ago, I can't say with certainty that the mood was not enhanced in any way.)

Well, it was funny back then. Now, it's a pretty horrible story on many levels. Forgetting about the brutality of the surgeon and the indelicate approach to the initial problem, it does illustrate one thing: pilonidal disease can be a bitch. If people were cars, along with the anus the tailbone area would be subject to recall and redesign. (Maybe this time it could be intelligent?)

"Pilo" means hair. "Nidus" derives from the Latin word for nest, and generally means the area in which a thing forms. In essence, pilonidal disease arises from the fact that some people have little dimples -- deep and narrow pits, really -- over their tailbones. Not always a problem, they can be a starting place for infection in many owners thereof -- particularly hairy people. Those pits are an indrawing of skin, along with the usual players in the skin: bugs, hair, etc. Although people of any body habitus can have problems, big hairy guys are the poster-children of the disease. It's a gigantic case of ingrown hair; and once infected, it's impossible permanently to eradicate it without some sort of surgery. Sometimes the amount of hair in there can be truly stupefying. Trust me, you don't wanna know. Tempting as it might be, had I a picture, I'd not link it. And that's saying something, as many readers know. But not all pilonidal infections have hair in them.

It's a surgical truism: when there are lots of widely varying operations to accomplish a thing, the perfect one remains undiscovered. And so it is with pilonidal disease. In part, that derives from the fact that it manifests itself in myriad ways. The rest is due to the fact that if you were to compile a list of ideal conditions to promote post-operative healing, the tail bone area is the antithesis, right down the line. Dark, moist, self-contaminating (being discreet here), and subject to tension which tries to pull an incision apart.

About the only straightforward decision is when a patient shows up miserable with a big pilonidal abscess. You drain the damn thing, and the patient will be immediately grateful (once again, the ancient and honorable and most basic tool of the surgeon: draining pus. Break out the air-freshener, Trish. I stunk up another exam room.) Other than that, who knows? Antibiotics alone for a little mild discomfort? Only remove the dimples? Simple excision of the "cyst?" (Cyst, by the way, is something of a misnomer, strictly speaking. It's a collection of infected gunk. "Cyst" implies an obstructed and filled-up gland, which is not what pilonidal disease is.) Leave open? Close? It's my experience that once you get to the point of an abscess that needs draining, you'll need some sort of surgical eradication or it will be a recurring problem. And it can be worse than an abscess: infection can track impressively under the skin, making a tunnel and popping up nearly anywhere else in the area (a pilonidal sinus.) If it surfaces vertically in the midline, you may get away with a fairly simple operation. The more off to the side, and the more tracks, the more likely it is you'll need some sort of complicated operation, widely to excise the area with creation of flaps to bring it all together again. When it's uncomplicated disease, as with an abscess having been drained, once it's healed a fairly small operation to excise the dimple and the formerly infected tissues underneath, with simple closure may do the trick. But slow healing, with an open wound requiring regular cleansing and shaving of the area, is a pretty common sequence of events.

All in all, an annoying and frustrating array of approaches for what seems a simple problem. We can transplant livers; we haven't figured out the best care for a tiny hole by the tailbone. My advice: if you're hairy and have a dimple "down there" but haven't yet had problems, keep the area shaved (it requires a sympathetic significant other) or invest in a depilatory creme. If you're a peach-skinned person, keep the area clean and dry (no powders) and your fingers crossed.

[Some time ago, a reader asked me about pilonidal disease, so this has been sitting around for a while. You'd be right in thinking I'm cleaning out the attic...]

I hate pilonidal disease. I've tried to close primarily after raising flaps, with varying results. There's just so much tension in that area, even 0-prolene can pull through in some cases. Healing by secondary intention probably gives the best long term results, but you have to prepare the patient for months of dressing changes.

I have been amazed how many people come in with pilonidal cysts that need drained to the ED. They sure LOOK like they hurt! I've helped with a fair bit of draining, never a pleasant olfactory experience, but always appreciated by the patient...

that is the most horrifying picture I've ever seen. I have negelected to visit your blog for awhile and when I return I am greeted with that ;)

Years ago, when I was pregnant, I assisted with a pilonoidal abscess drainage. Smells bothered me more than normal when I was pregnant and that smell was pretty horrific. Then the doc took his kelly clamp and started digging around in the abscess and started pulling out clumps of hair. It was too much for me, I barely made it out of the room. But the poor patient had been in agony and was profoundly greatful to have that thing drained and his pain relieved.

Pilonidal sinuses and abscesses: apparently quite prevalent among soldiers in WWII traveling on bumpy roads – Bailey & Love refers to it as “jeep disease” and then provides a foot note:jeep: US Army reconnaisance vehicle.(For the non-surgical medical chronies: Bailey & Love's textbook reminds one of a steatorrhoeal stool: pale, bulky and offensive.)

haha that reader was me. I had the closed excision May 9th, my stitches came apart at the bottom, the doctor had to cut open 2 stitches at the top because there was a huge amount of blood that built up. I've been packing both open wounds since May 23, had a wound vac for awhile, etc. They're looking at doing a cleft lift now. I'll find out tomorrow.

Oh, my. I get behind just to find out as I'm trying to catch up that you blogged about something I had never heard of 2 days before someone described having had the procedure recently! (His case wasn't so bad, apparently, for which I'm glad.)

I was told yesterday that I have one of these, a pilonidal abcess. Thanks to your site I am not extremely scared as to what will happen next,though an open wound that has to be packed with gauze every other day is not so appealing to me

Hi! I had a pilonidal cyst drained this past weekend and was just lookin around about them when I found your blog! The ER doc who saw me told me that they were caused by hair but when he examined me commented on my lack of. So, this disease is not only for hairy people! Mine was fairly small, so was cut and drained and 5 days later, I'm done packing it, just cleaning and covering. I laughed at your story because I had mine removed with no pain meds right in the ER. I refused narcotics because I'm breastfeeding. I regretted it when they started rubbing around in there!

Hi its anonymous from 2 posts agogot it drained by the casualty doctor who commented on how large it was! It was about the size of half an apple roughly, it got all red and angry looking after my GP prescribed me antibiotics. I have a question though, I have gauze packed in it to make it heal from the bottom down, (so the skin doesn't heal and leave the 2 inch deep hole!) but could there still be hair in it and stuff to be removed from it?

I had one of these and didn't know what it was. I was in increasingly excruciating lower back pain and thought I would die.

I didn't know what I had until one day I went in to use the bathroom. All of a sudden I had great relief. I stood up, wiped, and then just about passed out with all the blood and pus that was on the toilet paper. There was blood all over the toilet seat...it was bad.

It drained for a while and now seems okay. The thought of reoccurrence is not a pleasant one. Thanks for posting this, though. It's not a condition commonly known.

Geez, I'm dealing with one right now. I must say that it is one of the most painful experiences of my life. For it to recurr would cause me to take very drastic measures. Surgery and laser hair removal.

Anyone know of a hair removal clinic that charges by the square foot? :-)

Hey, thanks for writing this. I consider myself VERY lucky. I had one of these about 8 months ago and wow, talk about pain. I thought I bruised my tailbone at first, and it quickly escalated in to myself thinking I had broken my ass!

Sleeping became horrid and finally one day I woke up and noticed the back of my boxers was a tad bit wet. This is after going to see the doc and him telling em that he didnt want to drain it yet, he wanted to wait! Well, the initial pop was in the night right before I woke up and after that the story gets interesting.

I got out of bed and went to the bathroom, calling my room-mate in to see. He thought it was crazy, and to this day i thank god for his lacking ability to smell that day. He helped me drain the cyst for a good 20 minutes and I couldn't believe how much pus came out. I never went back to the doctor for it, just kept it bandaged for a few days, and my ass has been great since!

i just had one drained yesterday. having noticing a bump by my tail bone 4 weeks ago i finally went to emergency yesterday when the thing was the size of a golf ball and i couldn't stand the pain anymore.

Man the smell that comes with them draining is horrible!, and the pain is even worse, they say they are freezing the area but it doesn't feel like it.

i do have a question tho, the doctor has horrible writing which i can't read is instruction, how long do i need to keep the bandage over the area because he told me to sit in a bath with little water and wash away all the iodine and stuff but i don't know how long i got to wait before i can do this.

I hate to give specific advice when I don't know the situation. What I can say is that when I drained them I wanted people to start the bathing right away. The bandage is to catch the drainage, not to protect the wound.

I have no idea where this pilonidal cyst came from... My mom had it incised and drained by an operation 20 years ago and she seems great...Im terrified, my doctor sayd i need surgery, but the postoperation pictures i googled today are not encouraging at all..I mean i love my ass, i dont want it to be bruised and marked because of a stupid little bitchy dimple...Question: Is it painful??? ANd does the surgery leave a mark..or bruises on my tail mark??

mahmoud: if all you have is a dimple and have had no infections or other problems with it, some would say it's not necessary to do anything about it. It might be a problem in the future or it might not. As to what to expect from surgery, the best person to discuss that is the surgeon you would see, who would know what kind of surgery is planned.

Thank you for posting this! About 5 or 6 years ago I had it infected. The doctor said the sacral dimple that I had since birth was infected and formed a pilonidal abscess. He gave me an antibiotic as he said the surgery to remove it is very invasion and probably only necessary if I have a lot of painful recurring infections. Now, five years later, I believe I'm having my first recurrence... though it's not nearly as painful as the first time around it's slightly itchy and a little painful. I also have some pain in the lower left side of my back, but it's very manageable. The only thing is, I noticed it seems to be oozing by itself. I read online if it's oozing to contact your doctor. Well, I have a new doctor now, and they told me they can't help me. That I'd need to see a surgeon..they wouldn't even give me an antibiotic. Why is that?? And if it's not that painful and only slightly oozing, is it really necessary for me to see someone? Or should I just see if the "infection" goes away on it's own? No specialist will get me in for weeks, I'm sure, and I'm worried about this getting worse!! Please help!

lindsey: I'm really sorry but I can't give specific advice or suggestions when I don't know enough detail. Nor can I comment on why they didn't want to prescribe antibiotics. As a general proposition, it's better that it's draining than building up as an abscess, and applying heat, either by moist packs or soaking in a tub is almost always helpful. I have no way of predicting what will happen; the best advice you can get is by having it looked at, ideally by a surgeon.

My 17 yr. old son had a very painful pilonidal cycst lanced and drained last spring (after I attempted to do it myself at 3 a.m.!). The doctor said it was only a matter of time before he would have to have it surgically removed. Since my son will be going into a college ROTC program next fall and participating in all of the rigorous physical training, it seems now is the time to get it taken care of. We have a concern about the wound vac that he was told he would have to wear. Is it as painfull as it looks and does it make a lot of noise? (very important for a senior in H.S.!) I am concerned because he now wants to back out of the surgery next week after seeing pictures and being told just how long the healing process will be. How soon will he be up and around? Is there anything that I can do to ease the pain for him? I will also be the one to help change the gauze and bandages for him. I am just so worried and don't want to see him in such discomfort. Is it possible to heal and recover without the wound vac.? How can he possibly go back to school in early Jan. with such oozing bandages and/or a "shop-vac" as he put it attached to his back-side? The flip side to all this is that we can't see any other ideal time to get it taken care of. Thank you for any advice you can give.

atlanta mom: you asked excellent and important questions. Since there are many operations for this problem, as well as several types of drains and suction devices (none of which would make noise, and would easily hide under normal clothing, unless they're the type that plug in to a wall which is highly unlikely. Not every such operation requires a drain.), you should ask them of the surgeon. You have a right to get them answered, but he/she is the best one to do it.

Thanks very much for leaving me a post - I was star struck as I am half way through your book and have loved it.

I had just started my first clinical theatre attachment when I started it and was really shocked at how little things seemed to have changed. The way you describe the scrub nurses behaviour is still exactly the same!

I love this site and you and Buckeye surgeon are making me become more interested in surgery.

As a patient who's had a pilonidal cyst before, who's not a big hairy guy, actually a small, not particulary hirsute woman, I just to say that having the cyst drained was the most EXCRUCIATING experience of my life. Having the packing material in the core felt like having a brick beneath my skin. Anyhow, I just wanted to say that I'd shy away from painting the "classical" picture of the person with pilonidal disease as being a big hairy guy, because women (some hairy, some not), get it too.. and it creates a negative stigma.As a medical student and future MD, I try to be sensitive about the way I portray patients and clinical cases. The patients, are, after all, the vulnerable ones, who clearly do not want to be in that state ... and we should respect them, not make fun. Who knows, you might be the next person spread eagle on the operating table with your pants down and at the mercy of a fellow surgeon..

BrightEyes: well, clearly you'll be a much better physician than I, all sensitive as you are. And here I thought the picture of an obviously fake-furred guy would be recognized as such; and was, by all the commenters but you. In re-reading the post I find no making fun of anyone. And I clearly stated that people of any body habitus can get pilonidal disease. I even think there was useful information here. Silly me. All I did, evidently was stigmatize. All those people with scars on their tailbones, afraid to be outside, lest they be ridiculed. And all because of me. Painting the classical case of the person with the disease as the classical picture of the person with the disease, while mentioning the range: what a transgression. I'm ashamed.

By the way, if your drainage was excruciating, you had a more callous surgeon than I. And if she packed the wound that tight, a poorly trained one.

But you know us surgeons: crass, heartless, making fun of people to stigmatize them. All my posts, all 350+ of them, rated as one of the best medical blogs; all those comments of gratitude for understanding and helping: it turns out I was just hate-filled and destructive. If only I'd heard from you sooner. All those patient reviews over a 30 year career, expressing their deep satisfaction, saying I was the most caring doctor they'd ever had, wishing I'd do primary care... clearly wrong. Now finally, I find out from a med student the real deal about patients. I had no idea they were the ones who were suffering. I can only thank you for taking time out of your busy schedule to set me right, to teach me as I was never taught.

I only hope, for the sake of all of us, that when you get your first job you take your unique insights and sensibilities and straighten out those with whom you'll be working. You need to share your gift with the world.

Sid: I am sure BrightEyes' intention was not to insult or demean surgeons or any medical practitioner. You as a veteran of the medical field should be above the "insensitive" comments from a medical student...I guess "insensitive" is a relative term. I had to go to the hospital to get treatment for pilonidal cyst complications. When I got I finally saw doctor I found out that she did not want to treat me--I guess the knew what she was getting in to when she saw me. A second doctor came in and he was a "sensitive" doctor. I am glad he was there to help me. All I can tell you is that I remember her face and name...if I ever see her in distress I will on a highway, woods, city, etc. I will make sure I forget how to DIAL 911.

Should you happen to read this BrightEyes...Keep your sensitivity, people will thank for you it.

very informative. I have a non-hairy 12 year old which will be AT his doctors office this morning at 8:30 am. I traced the size w/ a pen last night, it is bigger this morning.. I love the 7 day a week practice. Is 12 young for this? He did have a large abscess in his arm last Thanksgiving. Antibiotics and draining cleared it up. I was very proud of him for taking care of it himself. (I monitored)

I have a 15 year old who has had 2 pneumothorax's, one each lung, this year (one in math class, one in lacrosse). I feel like all I do is see doctors.

How common is it for more than one member of the family to have this? I had open surgery aged 19,(not hairy and slim) long time healing, but no recurrence, bizarrely my husband also had one (hairy but slim), at 21, closed surgery, it did recur and he also had septicaemia. Today my 23 year old son has had his second lot of surgery, having initially had the abscess drained in January. The nurses tell him his wound is spectacular!! He is having a wound vac, and I am praying this will do the trick once and for all ( prior to original surgery he was given 5 lots of antibiotics - all dragged on far too long)Will this speed up the healing process, and are my other two non children doomed? What should they be doing to prevent this?

I don't know of data about families and pilonidal disease. Since the source is generally those dimples that some people have, it would certainly be possible that there are familial tendencies.

As to prevention: the first question is whether the kids have the dimples. If not, there's not much risk. If they do and are hairy, they could do something to reduce hair in the area: either shaving, or depilatories. I can't say I know if that works for people who've not had problems, and I sort of doubt there are prospective studies.

There are some fairly simple surgical ways to remove the dimples. It's arguable whether it should be done as a "preventative" measure. It's true that removing them before there's been infection means a much better chance of quick and uncomplicated healing, especially if simple surgery is done. (For example, some have had success using a skin biopsy punch.) I don't think I ever advocated the preventative approach, but I told people who had the dimples to be aware of the possibility of infection, and to seek help right away if it happens, because it's when infections are allowed to get big that it's a bigger surgical problem.

I had one removed from my tailbone about 20 years ago, after painful and frequent reoccurances. The final one was so bad I couldn't sit to drive, it was time for surgery. It was a simple office procedure either. It was "packed," and left it to heal from the inside out. The removal of packing a week later brought me to sobbing tears. Also had to have it cauterized twice for improper gristle growth, and it took a staggering 14 weeks to heal completely. I missed 3 months of work, and a whole sememter of college. Today, I have very slight reoccurances, nothing that would make me have that surgery again. To top it off, days after surgery I got the worst case of the flu in my entire life, with 104fever. Sorry, I can't add something uplifting and fun.

ck: as I said, when there are lots of ways to solve a problem it means the perfect one hasn't been found. The method that was used for you is one of many. When there's active infection, leaving it open to heal in slowly is often the best choice; as you found, it can take a long time. When it's possible to close primarily, with luck, it heals rapidly and cleanly.

No guarantees with any option. Everything about the area is the opposite of what's desirable for smooth healing.

i didnt realize so many people suffered with this problem I had mine removed 3 times by military doctors not saying military doctors are bad or maybe i have a persistant problem. After the last removal 5 years ago i still deal with it daily i shower in the morning and at the end of the day have some discharge in the back of my boxers i have learned to deal with it i am to scared to go back to any doctors for this so i am stuck wearing jeans the rest of my life for now. But after reading this maybe ill reconsider thanks

My husband is currently suffering from his second occurance (same location) of a pilonidal cyst. The first one went away with diligent expression and a course of antibiotics. I continue to tell him he is damn lucky he is married to a licensed vet tech, who enjoys expressing disgusting butt pustules. I have a good gross out story for all of your entertainment. The first occurance, we went to our GP and of course, while at the doctor's office, no evidence of purulent material. That night, he was tossing and turning because of the pain. I arose from bed to help comfort the area by expressing the cyst. I barely touched the thing and *Btht*, blood and pus all over my face. Talk about horrifying! Something for us to laugh at, and for me to take caution from.

Just curious, what's the record for number of operations? I just had my 4th on Monday, June 22. Last one was in 2005 and I thought it was gone forever. The healing process is so painful. Doctor, thanks for this blog. It's very informative, and comforting in a way knowing that there are others out there with the same aggravating problem.

O.K. All this information about recurrence is making me nervous. I've got a 20 year old, high-function autistic son, who is deathly afraid of needles, who has been diagnosed with pilonidal cyst disease (he didn't tell me about his "problem" for several months). His surgeon, when she looked at his posterior, said that the wound he has from the cyst and tunneling, is the worst she's seen. He's got the cyst, then he's almost completely open from the location of the cyst, down to his anus. As my son says, his "butt is cracked... get it, mom?"... at least he's got a good humor about it. My question is this: How likely is it that this could return, after having his whole butt "cleft" removed, then the edges sutured back together? Or is that even possible? Is it more likely that he'll have an open wound that I'll have to pack daily? I can handle taking care of him, that's not a problem. I'm very concerned about the level of pain my son will have to endure. They're thinking this can be done as an out-patient procedure. I'm leery of that, too.

There are so many possibilities, in terms of operative choices, and surgical findings, that I really can't give you much help, I'm afraid, from this far removed. Sometimes it's all unroofed and left open; sometimes, the infected tissues are cut away and a flap of skin and muscle is rotated in (when it's very extensive), and closed primarily. Between those two ends of the spectrum are several other possibilities.

I guess the only advice is to be sure various options are discussed and that the surgeon you choose has experience with the whole range.

Wow ... you have just helped me go through a cathartic reliving of the most humiliating medical experience of my life!

I was at college in Ann Arbor, and had a spectacular fall on the ice directly on my tailbone. I also had a boyfriend at the time who was into spanking. These two things led me to grit my teeth and soldier on through the pain, sure that I just had some sort of deep bruise or something, even though I could barely walk. (If only I hadn't blamed my bf he could have seen something was up ... but I was too mad at him to get naked ;)

One night after more than a week of this, I fell asleep with a heating pad on, and when I woke up it was covered with stinky blood. I *freaked out!!* It hadn't burst, it was just ... seeping.

At that point I could barely move. I took a cab to student health where I encountered a surgeon who seemed to believe I had purposely contrived the whole situation just to gross him out. I don't think he had the slightest sense that he was dealing with a terrified freaked out girl who was in incredible pain.

He never spoke to me directly but talked angrily about me as if I wasn't there, berating me in the third person to the nurses for letting the situation get as bad as it was. He swore. He loudly voiced his disgust over and over and over. Finally, I just broke into sobs and wailed "I fell on the ice!! I thought it would go away!!" I sobbed through the rest of the procedure.

Thank goodness I never had a recurrence. The bf redeemed himself by faithfully changing my tefla pads and bathing the area morning and night. But even 20 years later I can never quite shake the feeling when I see a doctor for anything that they hate me and think I am disgusting. :(

Thanks for posting on this topic! It makes me feel much less alone and freaky. I had one of these back in 1983 when I was 17. Fortunately, I had no pain with the cyst. I also had no smell when it popped because I was in the shower. I had no idea what it was. I thought the bump had been a zit. When it popped voluntarily and left a gaping hole the size of a pencil eraser, I was convinced I was going to die of cancer. (Shows you how goofy our thoughts work as teenagers!)

Our family doctor said it would need to be operated on and showed me a diagram of what I would look like on the operating table -- face down, butt in the air -- and I became hysterical. Of course as a 17 year old girl, my main thought was, "Will I be hideous 'down there' so that no man will want me??" The doctor ended up cutting a 2 x 4 x 2 hunk of flesh right down the middle of my butt-crack and installing a drain. I've seen pictures on the web of what it looks like but THANK GOODNESS I had no idea what it looked like back then. I was in the hospital for a week. The stitches were monstrously thick, black-coated cables of wire. Getting those removed was AWFUL!! I thought the doc was pulling out my spine like in that Vincent Price movie. I attended my first month of classes at college by standing up in the back of the class because I wasn't allowed to sit.

Despite all that embarrassment, the story has a good ending. You can't see the surgery scar at all; only visible are the tiny scars where the drain was installed. (I guess you could see the scar if my butt cheeks were pulled open -- but it's tough to do that without permission from the cheek-owner.) It hasn't recurred, thank goodness. The only thing that still kind of worries me is that the doc said that I had an 85% chance of getting another one. At 44, I haven't had a recurrence. I'm keeping my fingers crossed.

I do have a question. I've been informed I have a pilonidal cyst. That's all fine and dandy (oh yeah, that's right, no it's NOT). The last one was popped, drained, and silver nitrate was put on it that time and a couple visits after. Is that normal? And if so, well, I have another one and it's bleeding. Wwell, I think it's another one, but the last one didn't bleed. s it the same thing?

Of course, without examining it I can't say. But after the first time, it's not rare to see some blood, because healing tissue can be pretty bloody. Trying to get it to heal with silver nitrate, if it was a really small cavity, isn't crazy; but it's not very likely to have worked completely. So there could be a gob of "granulation tissue" in the cavity, which is healing tissue sort of gone amok. Sometimes silver nitrate works on granulation tissue, but not usually if it's in a deep hole.

I couldn't agree more with your post. Unfortunately my brother and I both suffer from pilonidal cysts. This is the 2nd one I could not get to drain (using ichthammol ointment) the usual way so I had to have it lanced. You will never love a Doctor more than to have him/her drain a putrid smelling, literal pain in the a**!!Thought my poor husband was going to pass out when he saw the scalpel sink down to the handle! :) Doc did an ultrasound and you could see that the cavity was about 3-4in deep, small cut off to the side, and left it open to drain.

About Me

I'm a mostly retired general surgeon. With my surgical blog, my intention is to inform, entertain, and possibly educate the reader about surgery, and about the life and loves of a surgeon: this one, anyway. Don't know what I'm thinking, doing a political blog, too.
In an amazing coincidence, I've also written a book, "Cutting Remarks; Insights and Recollections of a Surgeon." It's about my surgical training in San Francisco in the 1970s, aimed at the lay reader with the goal of entertaining with good stories, informing with understandable details of surgical anatomy, procedures, and diseases. Knowing you, I bet you'd enjoy it. In fact, if you like Surgeonsblog, you'll absolutely love the book!

Boring, Unoriginal, but Important Disclaimer:

What I say here is as true as I can make it, based on my experience as a surgeon. Still, in no way is it intended as specific medical advice for any condition. For that, you need to consult your own doctors, who actually know you. I hope you'll find things of interest and amusement here; maybe useful information. But please, please, PLEASE understand: this blog ought not be used in any way to provide the reader with ideas about diagnosis or treatment of any symptoms or disease. Also, as you'd expect, when I describe patients, I've changed many personal details: age, sex, occupation -- enough to make them into no one you might actually know. Thanks, and enjoy the blog.